2 Partenaires intervenants dans la PCIME-c au niveau de 55 DSOMSUNICEFUSAID MissionPFIZER (PPP)COMITES DE SANTEBASICS/USAID,RPM Plus/USAID,AFRICA 2010/USAIDPRN (contractualisation avec 12 ONG ou AEC)Plan InternationalAFRICARE/USAIDCCFPCSSCCROIX ROUGE SENEGALONG LOCALESThanks to many financial and technical partner's support scaling up IMCI at the community level had been quite easy in Senegal. 55 districts implemented some of the 16 key behaviors, 35 among them after KPC studies supported by the Reinforcing National Program of Nutrition. These studies helped them to identify the major local problems and to assess those who show priority. The situation is quite different concerning CCM of the major diseases killing Senegalese children (malaria, pneumonia and diarrhea).

3 Prise en charge du paludisme au niveau des cases de santé : PNLPExtension à tous les districts (P15/ABCD)552 cases de santé enrôlées en fin 2006 sur 1440 cases fonctionnelles recensées (38%)Introduction en 2009 des TDR au niveau communautaire (utilise pour l’instant qu’au niveau des structures de santé).CCM of malaria concerned first 15 districts with the combined treatment AQ+SP, and it’s now extended to all the 65 districts with ACT thanks to the Global Fund Initiative. More than 500 community sites are enrolled at the end of 2006 and soon in 2009, RDT will be available at community level.

6 Structures enrôlées au 22 mai 2008ExistantPlanifiéEligibleEnrôléRéalisé%Régions118100Districts65333046Postes>80034826017049Cases>1485>423>350>25560When we planned the scaling up of ARI-c, we wrote a guide and eligibility criteria for those who aimed to implement the strategy. These criteria are based on the opportunity of financial and technical support of a partner for the regions and districts, on the implementation of clinical IMCI for primary health facilities and on availability of equipment in weighing scales, timers and of instructed CHW for community sites.

7 Formation des formateursPlanifiéEligibleFormés% réalisé#SessionPool185168160868Infirmier Chef de Poste3482971584518TOTAL53346531826These are some results to share in the field of training. For the training of trainers

9 Formation en pharmacovigilance sur le cotri dans la prise en charge des IRA-cDSICPASCDatesKédougou71319/03/07Kolda1022/03/07Nioro826/03/07Louga628/03/07Thiadiaye03/05/07TOTAL4149We had one strong recommendation from the pharmacists for scaling up ARI-c : it was to make an operational research to study the side effects of cotrimoxazole. We did it in In 5 districts health workers and CHW have been trained about pharmacovigilance and followed. The results of this OR have been shared recently and were good.

10 Exemples de données IRA-c : Cas vus dans la région de Kolda entre août 2006 et Mars 2007 (9 mois)DistrictsCasT/RPniePGCotriréféréKolda13330985Sédh13165633Goudomp10132667Véling1697587789TOTAL53420231121317Here we have another example of how CHW treat children who are coughing. The results are from the region of Kolda who is of the rare region who monitor regularly community sites where ARI is implemented.

11 Facteurs de succes dans la prise en charge des IRA-cExistence d’ASC lettre dans certaines zonesExistence d’ONG locales capables d’apporter un appui technique et financier aux regions et districts desireux de passer a l’echelleImplication et information a toutes les etapes de la mise en oeuvre des IRA, de personnes et associations clefs (syndicat et ordre des pharmaciens)Revision de la Liste Nationale des Medicaments essentiels avec adjonction du cotrimoxazole au niveau case de santeWhy the implementation of ARI at the community level succeed in Senegal : we had in some region instructed CHW, local NGO ready to support technically and financially the region and districts who aimed to implement ARI-c, we involved and informed at real time of the key professional associations (pharmacists) since the beginning, that allowed us to put in the National List of essential drugs the cotrimoxazole at the community level when it had to be revised in 2006.

12 Points a améliorer dans la mise en œuvre des IRA-cSessions de suivi post-formation tardives et irrégulières sauf pour les districts de Sédhiou et Kolda ; inexistante au DS de NioroIrrégularité et non conformité des supervisions des cases (ECD au lieu ICP)Relâchement dans le suivi des activités IRA.c au niveau des districts pilotesImplication insuffisante de certains MCD (planification des activités, appropriation)However some aspects in the scaling up have to be improved to maintain the results we had during the operational research : post training supervisions are held very late or not held at all in some districts, formal supervisions are irregular or not respected in some districts where there’s insufficient involvement from the medical team and partners, there’s also a decrease in the involvement of some of the teams of the 4 pilot districts.